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Friday, September 4, 2020

Fluid Volume Deficit: causes, assessment, intervention

 Fluid Volume Deficit 


  • Dehydration occurs when the fluid intake of the body is not sufficient to meet the fluid needs of the body. 
  • The goal of treatment is to restore fluid volume, replace electrolytes as needed,  and eliminate the cause of the volume deficit. 
Type of fluid volume deficits

  • Isotonic dehydration 
    • Water and dissolved electrolytes are lost in equal proportions. 
    • Known as hypovolemia, isotonic dehydration is the most common type of dehydration. 
    • Isotonic dehydration results in decreased circulating blood volume and inadequate tissue perfusion. 
  • Hypertonic dehydration
    • Water loss exceeds electrolyte loss. 
    • The clinical problems that occur result from alteration in the concentrations of specific plasma electrolytes. 
    • Fluid moves from the intracellular compartment into the plasma and interstitial fluid space, causing cellular dehydration and shrinkage. 
  • Hypotonic dehydration 
    • Electrolyte loss exceeds water loss.
    • The clinical problems that occur result from fluid shifts between compartments, causing a decrease in plasma volume. 
    • Fluid moves from the plasma and interstitial fluid space into the cells,  causing a plasma volume deficit and causing the cells to swell.
Causes of fluid volume deficits 
  • Isotonic dehydration 
    • Inadequate intake of fluids and solutes
    • Fluid shifts between compartment 
    • Excessive losses of isotonic body fluids. 
  • Hypertonic dehydration - conditions that increase fluid loss, such as excessive perspiration, hyperventilation, ketoacidosis, prolonged fever, diarrhoea, early-stage renal failure, and diabetes insipidus.
  • Hypotonic dehydration 
    • Chronic illness
    • Excessive fluid replacement (hypotonic )
    • Renal failure 
    • Chronic malnutrition 

  • Thready, increased pulse rate
  • Decreased blood pressure and orthostatic (postural) hypotension
  • Flat neck and hand veins independent position 
  • Diminished peripheral pulses
Respiratory - Increased rate and depth of respiration 

  • Decreased central nervous system activity from lethargy to coma
  • Fever
  • Decreased urinary output
  • Increased urinary specific gravity 
  • Dry skin
  • Poor turgor, tenting present 
  • Dry mouth
  • Decreased motility and diminished bowel sounds 
  • Constipation 
  • Thirst
  • Decreased body weight 
Hypotonic dehydration: skeletal muscle weakness 

Hypertonic dehydration 
  • Hyperactive deep tendon reflexes 
  • Pitting oedema 
Laboratory findings 
  • Increased serum osmolality
  • Increased hematocrit 
  • Increased blood urea nitrogen 
  • Increased serum sodium level 
Nursing intervention 
  • Monitor cardiovascular, respiratory,  neuromuscular, renal, integumentary and gastrointestinal status.
  • Prevent further fluid losses and increase fluid compartment volumes to normal ranges.
  • Provide oral rehydration therapy if possible and intravenous (IV) fluid replacement if the dehydration is severe, monitor intake and output.
  • Generally, isotonic dehydration is treated with isotonic fluid solutions, hypertonic dehydration with hypotonic fluid solutions, and hypotonic dehydration with hypertonic fluid solutions 
  • Administer medication as prescribed such as antidiarrheal, antimicrobial, antiemetic, and antipyretic medication, to correct the cause and treat any symptoms. 
  • Administer oxygen as prescribed. 
  • Monitor electrolyte values and prepare to administer medication to treat an imbalance, if present 

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